title: The effect of inpatient stress testing on subsequent emergency department visits, readmissions, and costs.
abstract: BACKGROUND
  Patients with low-risk chest pain are frequently readmitted for evaluation of recurrent chest pain. It is unknown whether stress testing during the first admission for chest pain is a cost-effective means of reducing readmissions.
  
  
  METHODS
  Using a hospital administrative database, we conducted a retrospective cohort study of patients aged ≥18 years admitted under "observation status" to Baystate Medical Center between January 2007 and July 2009 for chest pain without acute coronary syndrome. We compared subsequent emergency department (ED) visits, readmissions, and costs within 1 year for patients who had a stress test at index admission to those who did not, adjusting for age, gender, race, insurance, and comorbidities.
  
  
  RESULTS
  The cohort included 3315 patients. Most (n = 2376, 71.7%) had a stress test during the index admission. Within 1 year, 256 (7.7%) patients returned to the ED at least once with chest pain. Of these, 112 (43.8%) were admitted during their first return visit. In the multivariable model, return visits for chest pain were negatively associated with previous stress testing (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.5 to 0.9). Once in the ED, however, the risk of admission did not vary by stress test during index admission (OR: 0.8, 95% CI: 0.4 to 1.4). Overall costs, including index admission and follow-up visits for chest pain, were higher for patients with stress testing at index admission.
  
  
  CONCLUSIONS
  Inpatient stress testing reduced subsequent resource utilization in terms of ED visits and resultant readmissions, but the savings were not enough to offset the cost of initial testing.
authors.affiliation: Division of Cardiology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Jaya
authors.initials: J
authors.lastname: Mallidi
authors.forename: Srikanth
authors.initials: S
authors.lastname: Penumetsa
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Friderici
authors.forename: Fadi
authors.initials: F
authors.lastname: Saab
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis* / Q000191:economics* / Q000503:physiopathology; D015331:Cohort Studies; D003365:Costs and Cost Analysis / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics* / Q000639:trends; D005080:Exercise Test / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies